Decoding depression

Decoding depression

A tremendous gift renews hope for cracking a complicated code.

By Jesse Lee

Charlie Kubly, the youngest of seven children, was a typical all-American boy. He loved music, having fun and joking with friends. He loved to travel and visited places like Maine, Colorado and Iceland, learning to ski and sail. He worked on earning a pilot’s license while developing a small mail order business that catered to college students.

He was the life of the party, always ready with a joke and a smile. But his gregarious personality hid a secret: Charlie struggled with depression.

Charlie was embarrassed by the disease and used his personality to hide his pain. “We called him the greatest actor of all time because he never showed any signs,” says his mother, Billie Kubly, describing how her son coped with depression. “He was the handsome, bright, funny kid that everyone loved, and he brought a lot of joy to our family.”

Billie realized something was wrong after Charlie came home from college. She found a bottle of St. John’s Wort, a natural herb supplement available over the counter at any drugstore. Billie knew that it was sometimes used as a natural remedy to combat depression. “When I found the bottle, I asked him straight out: ‘Do you think you have depression?’ He said ‘Yes,’’’ Billie remembers.

Charlie’s parents helped him access treatment. Despite five years of psychological care and a variety of antidepressants, he couldn’t find relief from the incapacitating disease. Charlie battled the agony and what he described as physical pain for years, until he took his life on Oct. 27, 2003. He was 28 years old.

Depression affects nearly 15 million people in this country or about 7 percent of Americans, according to the National Alliance for Mental Health. It’s a misunderstood disease, one with a biological basis that is thankfully coming into sharper focus.

Charlie’s parents, Dr. Michael and Billie Kubly, are determined to reveal the truths about the disease and erase the stigma surrounding depression. They founded the Charles E. Kubly Foundation to honor their son. The public charity is devoted to improving the lives of those affected by depression.

Michael and Billie took another step this year when they made a $5 million personal gift to the College of Health Sciences to establish the Charles E. Kubly Mental Health Research Center at Marquette.

The Kublys have been searching for a more-effective pharmacological option for the treatment of depression. When they saw the innovative work being done in the College of Health Sciences, they recognized that the potential for a breakthrough exists within the college’s collaborative neuroscience model. They hope their gift will accelerate the pace of discovering new and better medications for depression and related mental illnesses and help remove the stigma that can be a barrier to treatment.

People with depressionoften suffer from overwhelming feelings of sadness, stress and loss of interest, but they can also suffer physical symptoms such as nausea, fatigue, insomnia and chronic pain.

“We’re increasingly recognizing the impact of mental health on many aspects of physical health,” says Patricia Schroeder, R.N., administrator of the Milwaukee County Behavioral Health Division. “Certainly this is not a surprise as it reflects the wholeness — the mind, body and spirit — of a person.”

Billie saw this firsthand in her son. “Nobody talks about the physical pain of depression,” she says. “When someone can’t get out of bed due to the disease, it’s not just the mental anguish. There are severe physical symptoms, painful symptoms, that their body is going through.”

There is continued need for outpatient mental health services, particularly for underinsured populations, and there is also a need for new pharmacological treatments, according to Dr. John Schneider, chief medical officer for the Milwaukee County Behavioral Health Division. “There have been no novel medications brought to market since the late 1990s,” Schneider says. “Everything in the past few years has been so-called ‘me-too’ drugs.”

According to Dr. John Mantsch, chair of the Department of Biomedical Sciences in Marquette’s College of Health Sciences, this is exactly the reason why the research taking place here — and the Kublys’ transformative gift — are necessary. “Though currently approved antidepressants work in a subset of patients, their effectiveness is often limited and many depressed individuals don’t respond to them at all,” says Mantsch. “The result of treatment failures in these cases can be catastrophic. Suicide rates are very high in treatment-resistant depression.”

It can take up to six weeks for a medication to reach its full effect, and if the dosage or drug isn’t a good fit, a person can lose six weeks of treatment time. After repeating this cycle three or four times with no success and no relief, depressed individuals can become so frustrated that they quit treatment altogether.

“It’s an on-and-off cycle,” Billie says. “If the drug doesn’t work, they have to try a new one. If the side effects are bad, they’ll stop taking it. And when it does work, once they start feeling better, they’ll often stop taking the medication.”

Even if a person does find relief, anti-depressants can have adverse side effects, including nausea, insomnia, anxiety, weight gain and headaches, many of which mirror symptoms of the actual disease. According to a National Institutes of Health study, nearly 40 percent of patients taking an anti-depressant report side effects from the medication. And people who need to stop taking medication for any reason may experience severe withdrawal symptoms.

“Progress in treating these conditions requires the identification of new targets for medications,” says Mantsch. “Unfortunately drug companies are unable and insufficiently motivated to conduct the basic research necessary to accomplish this, leaving much of the burden on academic researchers.”

According to Mantsch, a co-founder of Promentis Pharmaceuticals Inc., a company that develops treatments for several central nervous system disorders, real progress requires a research environment that can meet three key criteria: The environment must value and foster basic science that can be translated into new treatments. It must encourage scientists to creatively pursue quality science beyond chasing grant funding and publication numbers. And it must be strategically constructed of talented neuroscientists with complementary research interests and technical expertise capable of working as an interactive team.

It’s no accident that is precisely the kind of research environment found in the Department of Biomedical Sciences, which currently comprises a dozen neuroscientists specializing in neuropsychiatric disorders.

A principal innovation at Marquette is the complementary approach, says Dr. William Cullinan, dean of the College of Health Sciences and director of the Integrative Neuroscience Research Center. Cullinan points to the strategic addition of faculty scientists with expertise in neurological systems as the defining characteristic of the center. “A key to making progress in understanding the basis of mental illness is to assess the brain’s motivational/reward system, its emotion-related circuitry, and the cognitive pathways that govern executive function and impulse inhibition,” he says. “These three systems overlap substantially, and by focusing our efforts at their interface we hope to pinpoint target for more effective, faster-acting biologically based treatment strategies.”

Dr. Peter Lake, medical director of the non-profit psychiatric Rogers Memorial Hospital and board-certified psychiatrist, calls the Marquette model “inspirational to all of us on the front lines who help patients and families in their daily battle with mental illness and psychiatric disorders.”

The Charles E. Kubly Research Center will bolster the College of Health Sciences’ research infrastructure and provide new tools to study questions that previously couldn’t be asked because of technological constraints. The gift also will fund the addition of neuroscience research faculty.

“We often think of depression as a single entity, when it is likely a collection of conditions with common symptoms, each of which has a slightly different neurobiological distinction,” Mantsch says.

Billie often quotes a Centers for Disease Control study that forecasts that by 2020 depression will be the second-leading cause of disability after heart disease.

She understands there is much work to be done and urges parents to talk to their children and acknowledge any sign or symptom of depression, no matter how small. “Keep a line of communication open with your children, and keep the conversation going,” she says. “Don’t be afraid to bring up depression and educate them on the symptoms to look for in themselves and their friends. I only wish I had known to have that conversation. The more we can talk about it, the more we can erase the stigma and find better treatments.”

Comments

There is some decent information in this article….great news and a great opportunity for some innovative thinking surrounding the causes and treatments of this disease. While the gracious gift made by Dr. Michael and Billie Kubly will undoubtedly make this possible, I can’t help but think that focusing on the depression aspect rather than praising them for their gift should have been the main focus of this article.

Dr. & Mrs. Kubly’s generous gift will touch the lives of many other people who, like Charlie, exhibit few outward signs of depression, and struggle with the disease daily.

I firmly believe Charlie will live on in the lives of others and they will benefit through the Kubly’s thoughtfulness. Indeed, what a legacy for Charlie to pass on to people he never met. Thank you Kubly family.

I’m deeply grateful to the Charles E. Kubly Foundation and the College of Health Sciences for the work they are doing. I regret that this article discusses noncompliance after successive treatment attempts without acknowledging that much research suggests that the effectiveness of pharmacological strategies diminishes with each additional attempt (most famously in the STAR*D study). “Non-compliance” after repeated treatment is often a rational, necessary weighing of pros and cons. Although it may be less frightening for some people, describing noncompliance in this situation exclusively as a result of frustration and discomfort with side effects feeds the stigma of irrationality in depression that people like me face from both professionals and the public significantly. Thank you.

Excellent article. This information and the efforts of Michael and Billie will save lives. I relate to the Charlie’s story as almost identical to mine, only my suicide attempt was fortunately unsuccessful. The stigma of mental illness is becoming less evident every day as we create the conversations that can lead to recovery. Much hope is being fostered as the research shifts to the neurobiological identification of the causes of depression. It is a brain disease and is now being treated as such. I am absolutely confident the Kubly’s gift will indeed will result in new medications for depression help remove the stigma. I deeply admire the Kublys for their contributions that will have a significant positive effect on the lives of millions of people suffering from mental illness. Today I am very proud to be a Marquette alumnus.